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Preventing a nonexistent entity

the curious case of contrast and acute kidney injury

Hiremath, Swapnila,b; Velez, Juan Carlos Q.c,d

Current Opinion in Nephrology and Hypertension: January 2020 - Volume 29 - Issue 1 - p 152–160
doi: 10.1097/MNH.0000000000000562
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Purpose of review In recent years, doubt has been cast on the existence of contrast-induced acute kidney injury. The skepticism has stemmed from observational studies from large administrative healthcare databases. Although they correctly call that contrast-induced acute kidney injury is less common than previously thought, they cannot completely exclude selection bias.

Recent findings Though less common than previously thought, contrast-induced acute kidney injury still exists. The only prophylactic method that remains valid is that of isotonic volume expansion, which is still deemed beneficial in high-risk patients. N-acetylcysteine and sodium bicarbonate are ineffective and their use should be abandoned.

Summary Contrast-induced kidney injury should be defined based on clinical grounds, not merely on biochemical numbers. More research to validate a clinical definition is necessary in order to accurately re-examine its incidence.

aDepartment of Medicine, University of Ottawa

bClinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada

cDepartment of Nephrology, Ochsner Clinic Foundation, New Orleans, Louisiana, USA

dOchsner Clinical School/The University of Queensland, Brisbane, Australia

Correspondence to Swapnil Hiremath, MD, MPH, 1967 Riverside Dr, Ottawa, ON, Canada K1H7W9. Tel: +1 6137388400 x82762; fax: +1 6137388337; e-mail: shiremath@toh.ca

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